Doctor Name: | MILDRED WILKS O'NEILL WHITE |
NPI Number: | 1083961726 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH9660 |
Business Practice Address: | 1324 Hartley Ave Deltona, FL - 327255608 |
Business Phone Number: | 3866268369 |
Business Fax Number: | |
Mailing Address: | 1324 Hartley Ave, DELTONA |
State: | FL |
Postal Code: | 327255608 |
Phone Number: | 3866268369 |
Fax Number: | |
NPI Enumeration Date: | 08/13/2012 |
NPI Last Update Date: | 08/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH9660 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |